In this episode, I’ll discuss suppressing unnecessary allergy alerts for beta-lactams with dissimilar side chains.
Hospital laboratories routinely suppress antibiotic sensitivity data on microbiology reports in the name of antibiotic stewardship. The practice is fairly straightforward – if E. coli is sensitive to ceftriaxone, there is no reason to mention it is also sensitive to cefepime or meropenem. Hiding these results will nudge providers toward using an appropriate antibiotic. If a unique scenario is present, the lab can always be contacted to release the suppressed data but the default scenario is to keep it hidden.
If the lab can do this type of data suppression to improve antimicrobial usage patterns, maybe the pharmacy can do something similar with allergy data.
A group of authors recently published in AJHP a retrospective quasi-experiemental study where they selectively suppressed allergy alerts for beta-lactam antibiotics with dissimilar side chains. The idea being, if these alerts were suppressed that carbapenem, monobactam, and non-beta-lactam prescribing rates would decrease.
Just over 800 patient encounters at a single center were analyzed and split into pre-alert and post-alert suppression groups.
The primary composite outcome was defined as receipt of a carbapenem, monobactam, or non–beta-lactam antibiotic for initial therapy. Secondary outcomes included documentation of a new beta-lactam allergy during the current admission.
When analyzed individually, there did not appear to be a change in carbapenem, fluoroquinolone, and aztreonam utilization in the post implementation group. However, when these 3 classes were combined into a composite, utilization of these antibiotics was significantly lower in the post-alert suppression group, dropping from 25% down to 15%.
As a safety metric to validate the appropriateness of suppressing the allergy alerts, documentation of new beta-lactam allergies was similar between the groups.
The authors concluded:
β-lactam allergy alert suppression yielded a significant reduction in initial composite prescribing of alternative agents. These findings, and the comparable rates of new allergies recorded in the postimplementation group, suggest that alert suppression may be safe and clinically meaningful in antibiotic selection.
There is definitely precedent in clinical practice with suppressing irrelevant data like the laboratory does, and this study represents a novel approach to doing the same but with allergy alerts instead of sensitivity results. Such a strategy should be implemented carefully, as the allergy field in the medical record is also used to document non-immune-mediated adverse effects. For example, if cefepime caused a patient to have a seizure in the past, this information is likely only documented in the allergy field of the medical record, and whether or not to use other beta-lactams in a patient with such a history has nothing to do with side chains. Therefore, suppression of allergy results should also take into account that the allergy field in the medical record currently serves a mixed purpose, documenting both allergies and important adverse effects that are not necessarily immune-mediated.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply